Automated External Defibrillator Visibility as Community Emergency Infrastructure: Implications for Willingness and Confidence among Residents of Underserved Communities to Perform Hands-Only CPR

Community resilience depends in part on visible and accessible emergency infrastructure that supports collective response to acute health crises. Sustainable communities require not only environmental and economic stability but also durable social systems capable of responding effectively to sudden health events. Automated external defibrillators (AEDs), when present in everyday environments, may function not only as clinical devices but also as components of community emergency infrastructure that shape response capacity and reinforce expectations of lay action. This study examined whether reported AED visibility was independently associated with Hands-Only cardiopulmonary resuscitation (CPR) response capacity in underserved populations beyond formal training exposure. Survey data from 372 adults participating in a culturally grounded cardiovascular health initiative were analyzed using multivariable logistic regression to evaluate associations between reported AED presence and comfort performing Hands-Only CPR on family members and strangers, as well as confidence responding to sudden cardiac arrest. Models adjusted for perceived informational sufficiency, psychological concerns, prior CPR certification, experiential exposure, and demographic characteristics. After adjustment, reported workplace AED presence remained independently associated with greater family-directed response capacity (OR 3.11, p = .005), whereas prior conventional CPR certification did not retain independent significance once informational and psychological variables were included. Perceived informational sufficiency and absence of concerns were the strongest predictors across outcomes. Findings suggest that AED visibility may operate as a structural component of community emergency infrastructure, reinforcing response capacity through mechanisms distinct from certification alone. Strengthening equitable visibility of emergency infrastructure alongside accessible education may enhance long-term adaptive capacity and resilience in communities disproportionately affected by sudden cardiac arrest.